SURVEY REQUEST

Project name:
From: (Section, Design Group)	Date Submitted:
Request initiated by:	Phone:
State/Federal/AIP Project #:
Desired Completion Date:	Program Code:	Activity Code:
Project Scope & Survey Limits: (include exhibits as attachments)	Project Phase:

(Please contact Right of Way Engineering prior to filling this out, as their requirements may directly affect the survey effort required. Include their response)

For each area the following information is needed: Alignment data or physical location of line (exist CL, top bluff, etc.); Desired contour interval; Distance or physical limits left and/or right from line desired. Please provide an attachment for each alignment.

Scope of overall project:

Scope of survey work requested:

Locate: (Fill empty slots if desired & Check all that apply)

Improvements	Drainage	Utilities	Right of way/Monuments	Other
Edge Pvmt., Curbs, etc.	Culverts	Above Ground	Front Corners Only
Structures	Ditches	O'head X-ings	Front & Back Corners
Sewer/Septic System	Storm Drain	Inverts	Monuments in Roadway
Bridge Site Survey	Encroachments

Vertical Control

Are there any elevation-critical features needing to be located?	☐Yes ☐No
If Yes, which datum are these features to be referenced to? (MSL, MLLW, MHW, Project, Geoid__, etc…)

Monuments in the road

Are there survey monuments in the roadway (from as-builts)?	☐Yes ☐No

Construction Schedule

When is construction anticipated to occur?

(This section for Survey Section use)

Survey Assigned to:	Estimated Completion Date:

Project History:

Hz/Vert Control:

ROW/Monument Ties:

TIN/Topo:

Other: